CTICasesParaesophageal Hiatal Hernia with Intrathoracic Gastric Volvulus and Partial Outlet Obstruction
[...]. Paraesophageal Hiatal Hernia with Intrathoracic Gastric Volvulus and Partial Outlet Obstruction. CTICases. Published October 1, 2026. https://cticases.com/c/9j2ye
Imaging findings
A baseline radiograph and matching CT in a 66-year-old show a hiatal hernia with an air-fluid level passing through the diaphragmatic hiatus. One week later the radiograph has changed dramatically, and CT shows most of the stomach now in the chest, pressed against the ribs and distended with fluid because it is not emptying. The antrum remains in the abdomen and the stomach has not flipped upside down. A large clump of tissue at the hiatus suggests a twist. The crura cross with a small posterior defect, but the diaphragmatic domes appear intact. After a decompression tube was placed, coronal reformats show the decompressed stomach re-entering the abdomen through the same posterior crural defect.
Key takeaways
A hiatal hernia can enlarge quickly into an intrathoracic stomach without trauma or surgery. A bunched mass of tissue at the hiatus with a distended, poorly emptying intrathoracic stomach should raise concern for gastric volvulus causing partial outlet obstruction, which is an acute situation. The diaphragm is hard to evaluate in any single plane, so use coronal and sagittal reformats to trace the esophagus, the gastroesophageal junction, and the crura.
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